Laparoscopic staging in hilar cholangiocarcinoma: Is it still justified?

Abstract

Radical resection remains the only potential curative therapy for hilar cholangiocarcinoma (HCCA). The aim of staging laparoscopic (SL) is to identify patients with previously undetected advanced disease who will not benefit from surgical palliation and therefore avoid unnecessary laparotomies. The accuracy of non-invasive imaging techniques has significantly improved during the last years. As a consequence, the diagnostic yield of SL of biliary tract malignancy should have decreased proportionally. At the same time, some authors have recently questioned the value of laparoscopic ultrasound (LUS) as a complement of SL. In this setting, the precise role of SL and LUS in the preoperative workup of HCCA remains unclear. As it seems undoubtedly clear that its efficacy has decreased in the last decades, there is a general consensus that the universal use of SL shouldn't be recommended anymore; SL should be performed only in selected patients with higher risk of holding unresectable disease (T2/T3 or Bismuth type 3/4 and patients with suspicion of metastases). It would also be recommended in patients with potentially resectable disease who would need preoperative invasive procedures. Finally, SL should be performed preceding laparotomy in one session. Further studies on the benefit of SL and LUS in this subset of HCCA patients are warranted.

Role of laparoscopic ultrasound during diagnostic laparoscopy for proximal biliary cancers: a single series of 100 patients

“…Actually, there is no consensus about the usefulness of DL in patients with HC. A recent review [23] reported that OY and AC have decreased through the years from 41 and 72 %, respectively, to 14 and 32 % in the more recent series. This limited value of DL in the last years was confirmed in a large single series of 175 patients, [24] and it is likely the result of imaging techniques improvement.…”

<p>Management Strategies for Patients with Hilar Cholangiocarcinomas: Challenges and Solutions</p>

“…With the improvements in diagnostic CT/MR, the yield of staging laparoscopy in changing the management in patients with hilar cholangiocarcinoma has decreased to 13-17%. 66,67 Song et al and Nagino et al have not described regular use of staging laparoscopy in their studies. However, Jarnagin et al have shown selective use in patients with Blumgart T2 and T3 lesions, or if there is advanced disease on preoperative imaging.…”

Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

“…The role of laparoscopic exploration (LE) decreased over time together with the increase of sensibility and specificity of imaging techniques. Routine LE is not recommended, but it can be useful in T2/T3 pCCC according to AJCC classification or type III and IV according to Bismuth-Corlette[ 92 , 109 ]. LE is the only way to detect peritoneal metastasis prior to laparotomy, due to the low predictive value of non-invasive technique.…”